Gout Information

How is uric acid (urate) produced in the body?

Many of the foods we eat contain chemicals called purines. Purines are nucleotides - that is, they are the basic molecular building blocks of DNA. Along with other nucleotides, purines are sources of energy that drive most of our bodily processes. After digestion, some purines are absorbed by the intestinal mucosa into nucleic acids. The others are rapidly degraded into uric acid. It is when the ability of the kidneys to eliminate uric acid (via the urine) is compromised that raised levels of uric acid occur - a condition known as hyperuricemia. 'Hyper' means increased, 'uric' refers to uric acid and 'emia' (sometimes spelt aemia) means blood. Thus hyperuricemia means raised levels of uric acid in the blood.

Raised levels of uric acid can be caused:

when less uric acid is removed (via the kidneys) from the body than usual;
when more is produced (by the liver) than normal;
when both of the above occur.

Hyperuricemia

In testing for gout, the concentration of uric acid in the blood serum is measured and is a reflection of levels throughout the body. The recommended range of uric acid levels is less than 6 mg per 100 ml; the range of raised levels is 6-9 mg per 100 ml; and high levels are defined as more than 9 mg per 100 ml. Many people without gout have raised levels of uric acid, which is seen as an indication that the condition is liable to develop in them in future. Urate crystals take a long time to accumulate, and there may well be no symptoms whatsoever for months or even years -in fact about 95 per cent of people with hyperuricemia will remain symptom-free throughout their lives. On the other hand, a large study in the USA revealed that all participants with high concentrations of uric acid developed gout within four years.

In most cases of gout, there is no clear reason for the build-up of uric acid. However, it is known that certain factors can be responsible. These include:

a high-purine diet
poor kidney function or kidney disease
being overweight
high levels of fats (lipids) in the bloodstream
high blood pressure (hypertension)
regular, excessive alcohol consumption, or binge drinking
the presence of certain diseases
the use of certain medications
inheritance of certain genes

Because gout was uncommon during and immediately after the First and Second World Wars, there is strong case for its still being referred to as 'the disease of plenty'. In fact, an acute attack often follows an evening of wining and dining or a holiday where restraint is set aside. The disorder is manifest typically in the overweight, hypertensive, overindulgent middle-aged or elderly male.